More hospitals to allow patients to see doctors via video

SINGAPORE – More than a decade after hospitals here started experimenting with the technology, a national platform for telemedicine was launched on Wednesday (April 12), paving the way for restructured hospitals and other healthcare institutions as well as possibly general practitioners in the future, to offer consultations remotely.

Under the initiative, patients can - via the VidyoMobile application - consult doctors on selected conditions from the comfort of their homes or anywhere else as long as they have an Internet connection, and if needed, get the expert opinion of other specialists.

For now, the service is typically offered for follow-up consultations for patients with mild to moderate conditions and that do not require physical examinations.

KK Women's and Children's Hospital (KKH), the Institute of Mental Health, Tan Tock Seng Hospital and Singapore General Hospital are already on board, offering the service for areas such as speech therapy, paediatric home care services, psychiatric counselling and supporting patients with communicable diseases. About 190 patients across these institutions are currently using the service.

By June, the Smart Health Video Consultation platform will be introduced at the National University Hospital and the National University Cancer Institute to care for stroke patients at offsite wards and cancer patients, respectively. The Eastern Health Alliance plans to use the platform for training and case reviews across multiple nursing home sites by the end of this year.

Integrated Health Information Systems (IHiS), the IT arm of the Ministry of Health, will implement the platform. It told TODAY it is looking to roll out the service to primary care practitioners, polyclinics, and private sector players. Healthcare providers will have to be granted access by IHiS and pay a fee to use the platform.

It is currently in talks with an unnamed healthcare group.

Describing telehealth as a "gamechanger", MOH chief medical informatics officer Low Cheng Ooi said: "The convenience factor, the fact that we can improve productivity and maybe reduce the number of visits on our specialists' side will be beneficial. It also (aligns with) the ministry's philosophy of moving (care) from hospitals to home... but (the transition) will take time."

Assoc Prof Low noted that in the event of a pandemic, the platform also helps lower the population's risk of exposure to infectious diseases.

Nevertheless, he noted that here, both healthcare practitioners and patients may have to overcome "cultural challenges" to reap the benefits of the new service. "We have to make sure that there is patient acceptance… For years and years you have been seeing a physical person and (now) simply looking into the camera… may be uncomfortable for some people… So we are not really in a rush to push technology... it is really about getting suitable patients on board," he said.

He stressed that the selection of patients to use the service would be critical. "(For some conditions) you can't just throw away the stethoscope and replace it with a camera… What we don't want is a sudden surge of people saying they don't need a clinic and can just operate from home," he said. "That is something we are concerned about at the regulatory level - that you don't deteriorate the care you are supposed to be providing as a license holder, and jeopardise the patients' health."

Based on studies in other countries, MOH believes the new platform will improve access to healthcare, especially for the elderly and patients with mobility issues, reduce travel time and time spent waiting at clinics, as well as shave medical costs.

Since November last year, KKH's dermatology service has offered the option of video consultation to about half of 60 new paediatric patients a week. These patients pay S$32 for a package which includes a face-to-face pharmacy counselling session and a video consultation, about one-third the cost (S$85 to S$98) of a follow-up consultation in the clinic.

For the past five months, IMH has also been offering video consultation to residents or clients enrolled in the day care activities at four residential homes.

Dr Kelvin Ng, a consultant at the IMH's department of community psychiatry, said the initiative has led to better management of resources. "Staff from the nursing homes will locate and prepare the patients in advance before the video consultation or help to remind the patient should he forget about the appointment," he said. "Patients do not have to wait as they are only called when it is time for them to be seen (by the doctors)."

Currently, some hospitals in both the public and private sectors have their own video consultation platforms. For example, Parkway Shenton, a private primary healthcare provider operating over 65 clinics island-wide, plans to introduce tele-consultation services on its own platform to patients later this year.

Khoo Teck Puat Hospital (KTPH) has also been offering such services for patients in nursing homes. Between December 2010 and Febrary 2017, a total of 2039 residents from eight nursing homes were seen via teleconsultation. Dr James Low, senior consultant at KTPH department of geriatric medicine, said: "If the national platform meets our requirements then we will join it."

Apart from tele-consulting, two more services will be introduced at the national level later this year: Next month, rehabilitation services - such as for those undergoing physiotherapy - will be offered while in September, doctors can also use the platform to monitor patients' vital signs.

Clarification: An earlier version of this story said between December 2010 and February last year, more than 2,000 tele-consultations involving almost 770 residents from eight nursing homes were conducted by KTPH. The hospital has clarified that the teleconsultation service was offered between December 2010 and February this year to 2039 residents.